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Swapna Shanbhag, Hajirah Saeed, James Chodosh; A Systematic Literature Review of Keratolimbal Allograft after Corneal Chemical Burn. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5671.
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© ARVO (1962-2015); The Authors (2016-present)
To review the published literature on outcomes of keratolimbal allograft (KLAL) for the surgical treatment of corneal blindness secondary to corneal chemical burn.
Literature searches were conducted in the following electronic databases from January 1, 1984: MEDLINE, EMBASE, Science citation index, CINAHL, LILACS, and the Cochrane Library. Standard systematic review methodology was applied. Databases were last searched on September 30, 2016. There were no restrictions applied to study design, study population, or language. Reference lists were scanned to identify additional applicable studies. The quality of each published report was assessed. The main outcome measure was improvement of 2 Snellen lines or more of best-corrected visual acuity (BCVA).
We identified 11 reports where outcomes in eyes with chemical burns could be distinguished. Individual studies were rated. There were no randomized control studies. With one exception, all studies were retrospective, non-comparative case series. Five studies had defined outcome measures. The outcomes of KLAL in 65 eyes with corneal chemical burns in these 11 studies were analyzed. 78.5% eyes underwent simultaneous or subsequent penetrating keratoplasty. All patients received oral immunosuppression. With a mean follow-up period of 29.9 months, improvement in BCVA of 2 or more lines was noted in 56.8% of eyes. Repeat KLAL was required in 29.2% eyes. Rejection of the corneal graft was noted in 49.1% eyes. Further surgical interventions were required in 70.8% of eyes.
The number of studies where outcomes of KLAL in eyes with chemical burns could be discerned was limited, and large variability was observed in outcome reporting. The overall quality of evidence was low. Standardization and longer follow-up are needed to better define evidence-based best practice when contemplating surgical intervention for corneal blindness after chemical burn.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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